By John Salak –
Put this piece in the good news/bad news file. Hospitals in the U.S. are loaded with the latest technology for treating heart attack victims. They also have some of the lowest readmission rates in the world. Yes, those are two pieces of good news when it comes to dealing with heart attacks.
These treatment talking points have to be particularly reassuring to the more than 800,000 U.S. residents who experience a heart attack every year. For those keeping score, this equates to an attack every 40 seconds, according to the Centers For Disease Control and Prevention.
For all these benefits, a new study out of the University of Texas, Galveston unfortunately found that the U.S. also has one of the highest mortality rates among high-income countries when it comes to heart attacks. The Texas team also discovered substantial differences in related care across the six countries it studies despite international agreements that are in place on how to prevent heart attacks.
Cram and his collaborators came to their conclusions after examining data from heart attack patients 66 and older who were admitted to hospitals in the United States, Canada, England, Netherlands, Israel and Taiwan between 2011 and 2017. These countries were chosen because of their highly developed healthcare systems and accessible administrative data.
The United States admittedly fared well with cardiac revascularization—procedures to treat coronary artery blockages—while also registering low hospital readmission rates. However, the country’s mortality rate was “concernedly high,” Cram said.
“The U.S. seems to focus really hard on those technologically advanced new and shiny things,” he said. “Maybe, from a policy perspective, we should focus more on the mortality rate instead of getting people in and out of the hospital.”
England and the Netherlands, by comparison, seemed to have lower mortality but far lower revascularization rates.
“It seems to be about tradeoffs,” Cram explained. “Israel really seemed to be an exception, the only country that really seemed to perform well across all measures.”
Ultimately, these previously unknown insights may or perhaps should force U.S. hospitals and doctors to re-examine how they treat heart attack patients.
“We should be comparing ourselves to high-income countries as a mechanism for identifying where we are performing well and where we should focus our improvement efforts,” Cram added. Admittedly, however, just what is leading to relatively high U.S. mortality rates is not clear.
“What is happening to our patients who have had heart attacks after they leave the hospital?” Cram asked. “Is it gaps in wealth? Is it obesity rates? Is it people not taking recommended medications? We don’t know.”
Answers are needed and quickly because the end game is saving lives and not simply treating patients.
“From a U.S. perspective, our heart attack care is good, but the one-year mortality rate is concerning,” Cram said. “If dying is one of the things we want to prevent, then we have work to do.”